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Federal health official initially thought cause of 2012 meningitis outbreak would be found in Nashville

A top federal health official testified today that he first thought that the cause of a growing and deadly outbreak would be found in the Nashville clinic where the first case of fungal meningitis was reported.

Federal health official initially thought cause of 2012 meningitis outbreak would be found in Nashville

The two antifungal medicines being used to combat fungal meningitis, amphotericin-B and voriconazole, here Oct. 10, 2012, have vicious side effects. The drugs fight the fungus but can damage the liver and kidneys.(Photo: John Partipilo / The Tennessean)Buy Photo

BOSTON — A top federal health official testified today that he first thought that the cause of a growing and deadly outbreak would be found in the Nashville clinic where the first case of fungal meningitis was reported.

Dr. Benjamin Park, testifying as the lead witness in the racketeering and second degree murder trial of Glenn Chin, said that while he first suspected the outbreak was limited to the Saint Thomas Outpatient Neurosurgical Center in Nashville, Tenn., he soon learned the outbreak traced back to the Massachusetts drug compounding firm that shipped contaminated steroids to clinics in 23 states, including Tennessee.

Park testified after Assistant U.S. Attorney George Varghese told jurors its was Chin who was responsible for sending out contaminated drugs that killed the 25 patients in seven states.

Citing the case of Kentucky Judge Eddie Lovelace, who was injected at the Nashville clinic, Varghese said it was Chin who certified that the vials of methylprednisolone acetate were sterile.

Instead, he said, they were contaminated with deadly fungi that traveled to Lovelace's brain eating blood vessels and causing a massive stroke.

Chin's legal team made an immediate call for a mistrial because he said Varghese had given jurors misinformation about the standards required of the New England Compounding Center, which employed Chin as a supervisory pharmacist.

U.S. District Judge Richard G. Stearns denied the mistrial motion but then clarified for jurors the source of the standards NECC was expected to meet.

Stephen Weymouth, Chin's lawyer said in his opening statement that prosecutors were attempting to portray Chin as "a horrible villain" who was responsible for the outbreak.

Citing statements by prosecutors in the recent trial of co-defendant Barry J. Cadden, Weymouth noted that they called NECC "Cadden's baby" and that they repeatedly claimed that everything that happened at the now defunct Framingham, Mass. company happened because Cadden ordered it.

Cadden was convicted of racketeering and mail fraud charges but cleared of the same 25 second degree murder charges now facing Chin. Cadden was given a nine year prison sentence.

Park, an official of the U.S. Centers for Disease Control and Prevention who also testified in the Cadden trial, said the first word of a possible outbreak came from Dr. Marion Kainer of the Tennessee Health Department. In a call in early September of 2012, Kainer told the CDC a patient had died after being injected with a spinal steroid at the Nashville clinic.

As additional cases were reported, Park said he became more and more concerned. He said the strokes were in an unusual area at the center of the brain.

He said there were a lot of common denominators in the initial cases which caused him to think something was going wrong at the Nashville clinic. He said that feeling was reinforced after a conference call with Cadden and another NECC officer who told the CDC there had been no other complaints from NECC customers.

A turning point came when a new case was reported at a North Carolina clinic on Sept. 26. That clinic also had purchased steroids from NECC and the victim suffered the same unusual stroke.

"This told us it was outside the (Nashville) clinic," Park said.

While relieved they had found the source, Park said he also learned that some 14,000 doses of suspect steroids already had been injected in patients in 23 states.

"I was quite scared," Park said.

On cross examination by Weymouth, Park was challenged on his comparison of the meningitis outbreak with an ebola epidemic that killed thousands of victims.

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Dr. David Reagan, left, chief medical officer for the Tennessee Department of Health, and Dr. Marion Kainer, also with the state Health Department, tell local and national media about an outbreak of fungal meningitis infections during a news conference Oct. 1, 2012.
Shelley Mays / The Tennessean

Dr. David Reagan, right, chief medical officer for the Tennessee Department of Health and Marion Kainer, also with the state Health Department, tell local and national media about an outbreak of fungal meningitis infections during a news conference Oct. 1, 2012.
Shelley Mays / The Tennessean

Teresa Russell, second from left, comforts her brother, Jeffrey Russell, left, as he talks about their mother, Janet Russell, on Oct. 5, 2012, in Nashville. Janet Russell was suffering from a deadly fungal meningitis after getting steroid shots for back pain. Sister Tracy Barreiro is seated second from right, and father Bobby Russell is at right.
Mark Humphrey / AP

"Some experts believe vigilance for up to three months will be necessary," state Health Commissioner Dr. John Dreyzehner said in announcing a longer incubation period for recipients of tainted steroid shots during a news conference Oct. 5, 2012.
John Partipilo / The Tennessean

Virginia Clark holds her dog Precious in her Pegram, Tenn., home Oct. 8, 2012. Clark got a steroid epidural for her back a month before but has had no symptoms of meningitis. She feels she is out of the woods.
Shelley Mays / The Tennessean

John Dunn, deputy state epidemiologist, stands in front of graphics mapping the meningitis outbreak at the Operations Center of the Tennessee Department of Health on Oct. 8, 2012, in Nashville.
Dipti Vaidya / The Tennessean

People work at the State Health Operations Center in the Tennessee Department of Health on Oct. 8, 2012, in Nashville. Health officials in Tennessee were reviewing recent deaths that were not initially linked to a deadly fungal meningitis outbreak.
Dipti Vaidya / The Tennessean

George Cary, left, speaks at his home with his daughters Heather Andrus, 33, middle, of Howell, Mich., and Jill Bloser, 43, of Charleston, S.C., in Howell, Mich., on Oct. 9, 2012. Cary, whose wife's death was linked to the national outbreak of fungal meningitis, said that he, too, was treated with steroids that may have been contaminated.
Paul Sancya / AP

The Minnesota Department of Health shows vials, here Oct. 9, 2012, of the injectable steroid product made by New England Compounding Center implicated in a fungal meningitis outbreak that were being shipped to the Centers for Disease Control and Prevention in Atlanta from Minneapolis.
AP / Minnesota Department of Health

Laboratory technician Ruth Rutledge packages cerebrospinal fluid of confirmed meningitis cases in Minnesota on Oct. 9, 2012, to send to the Centers for Disease Control and Prevention in Atlanta for further testing. Officials have tied the outbreak of rare fungal meningitis to steroid shots for back pain.
Hannah Foslien / AP

The two antifungal medicines being used to combat fungal meningitis, amphotericin-B and voriconazole, here Oct. 10, 2012, have vicious side effects. The drugs fight the fungus but can damage the liver and kidneys.
John Partipilo / The Tennessean

Ameridose Sterile Admixing Services, here Oct. 10, 2012, is the pharmacy connected to the New England Compounding Center linked to a deadly meningitis outbreak, and which officials said has agreed to be shut down for state and federal inspection.
Marshall Wolff / AP

Two men stand guard Oct. 11, 2012, outside the entrance to Ameridose LLC in Westborough, Mass., a separate pharmaceutical firm with common ownership of New England Compounding Center, the source of steroid shots suspected in the outbreak of rare fungal meningitis.
Elise Amendola / AP

This undated image made available by the Centers for Disease Control and Prevention shows the Exserohilum rostratum fungus. The CDC said Oct. 11, 2012, that tests have shown Exserohilum fungus in 10 people sickened in the fungal meningitis outbreak. It's a common mold found in soil and on plants.
AP / CDC

Dr. David Reagan, chief medical officer at the Tennessee Department of Health, left, speaks a panelists Woody McMillin, state Health Department, second from left, Lisa Green, health editor at The Tennessean, and John Hollis, right, listen during an informational meeting about the meningitis outbreak, sponsored by The Tennessean, at the First Amendment Center on Oct. 15, 2012.
Sanford Myers / The Tennessean

Terri Lewis, of Cookeville, Tenn., gives her opinion during an informational meeting about the meningitis outbreak, sponsored by The Tennessean, at the First Amendment Center on Oct. 15, 2012, in Nashville.
Sanford Myers / The Tennessean

Ken Pierce of Eddyville, Ky., who has had a steroid injection, asks a question during an informational meeting about the meningitis outbreak, sponsored by The Tennessean, at the First Amendment Center on Oct. 15, 2012, in Nashville.
Sanford Myers / The Tennessean

Gene Policinski, senior vice president/executive director of the First Amendment Center, left, looks on as Dr. David Reagan, chief medical officer at the Tennessee Department of Health, middle, answers a question as panelist Woody McMillin of the state Health Department, right, listens during an informational meeting about the meningitis outbreak, sponsored by The Tennessean, at the First Amendment Center on Oct. 15, 2012.
Sanford Myers / The Tennessean

Gregory Clucker, of Nashville, who has had steroid injections, asks a question during an informational meeting about the meningitis outbreak, sponsored by The Tennessean, at the First Amendment Center on Oct. 15, 2012, in Nashville.
Sanford Myers / The Tennessean

Dr. Stephen Porter speaks from the audience during an informational meeting about the meningitis outbreak, sponsored by The Tennessean, at the First Amendment Center on Oct. 15, 2012, in Nashville.
Sanford Myers / The Tennessean

A local police officer stands at the doorway as an investigation takes place in the office of New England Compounding Center in Framingham, Mass., on Oct. 16, 2012. The company's steroid medication has been linked to a deadly meningitis outbreak.
Bill Sikes / AP

Even after a two-week hospital stay, Nashvillian Joan Peay, at her home Oct. 25, 2012, still must take medicine for fungal meningitis through an IV tube twice a day until at least Thanksgiving. She said she has been told she will be taking pills for at least three months after that.
Samuel M. Simpkins / The Tennessean

U.S. Rep. Ed Markey, D-Mass., speaks at a news conference outside the New England Compounding Center in Framingham, Mass., on Nov. 1, 2012. Markey outlined a plan to more closely regulate compounding pharmacies like the NECC, which is linked to a deadly nationwide meningitis outbreak.
Elise Amendola / AP

Joyce Lovelace, right, is joined by Rep. Ed Whitfield, R-Ky., as she testifies at a House Oversight and Investigations subcommittee hearing Nov. 14, 2012, in Washington. The hearing was called to examine the outbreak of fungal meningitis and other infections linked to contaminated injectable products made and distributed by the New England Compounding Center. Her husband died Sept. 17, 2012, of what is believed to be fungal contamination from a series of epidural steroid injections.
Joe Brier / Gannett

Dr. Marion Kainer, left, director of the Healthcare Associated Infections & Antimicrobial Resistance Program at the Tennessee Department of Health, chats with Sen. Lamar Alexander, R-Tenn., before a Senate Committee on Health, Education, Labor & Pensions hearing in Washington on Nov. 15, 2012. The hearing was called to examine the implications of the outbreak of fungal meningitis and other infections linked to contaminated injectable products.
Joe Brier / Gannett

Sen. Lamar Alexander, R-Tenn., speaks to a panel of specialists during a Senate Committee on Health, Education, Labor & Pensions hearing in Washington on Nov. 15, 2012. The hearing was called to examine the implications of the outbreak of fungal meningitis and other infections linked to contaminated injectable products.
Joe Brier / Gannett

Bret Moody, left, describes his constant pain as he and his wife, Joy Coker Moody, talk about his ordeal with fungal meningitis during an interview in their home in Florence, Ala., on Nov. 16, 2012. Bret Moody says he contracted fungal meningitis after being treated for cancer symptoms with drugs from the New England Compounding Center.
Steven S. Harman / The Tennessean

Bret Moody, left, listens for the first time to a recording his wife, Joy Coker Moody, made of him yelling in pain while he was in the hospital earlier this year. They talked about his ordeal with fungal meningitis during an interview in their home in Florence, Ala., on Nov. 16, 2012.
Steven S. Harman / The Tennessean

Joan Peay, at her Nashville home Jan. 7, 2017, suffered double bouts of fungal meningitis tied to tainted steroids sent out by a Massachusetts pharmacy in 2012. More than 60 people nationwide were killed by the outbreak, and 700 were sickened.
George Walker IV / The Tennessean

Weymouth also presented records showing thousands of vials of NECC drugs were shipped and injected in patients without any evidence of injury. He also raised questions about the lack of evidence that one of the three lots of suspect steroids actually harmed anyone.

In his opening statement Weymouth said the second degree murder charges were unjustified.

"It's not murder," he said, adding "he (Chin) did make mistakes for sure."

Instead he said that despite the intensive federal investigation, the exact fungus contained in the steroids was never found at NECC.

"No one could determine exactly what happened in that clean room," he said.

In his opening statement Varghese showed jurors an email from Cadden to Chin in which he reported a "fungal bloom" had been detected in the clean room. That was just one day before one of the suspect lots was prepared.

Nonetheless, Varghese said, NECC failed to inform federal investigators about that finding when the investigation was underway.

And the prosecutor said there were multiple other problems with NECC drugs including some contaminated with bacteria and others made with outdated components.

He cited an email from Chin to Cadden in which he described one component of a juvenile cancer drug this way.